The Tough Ones

That is, EMS is the business of dealing with people. Even at their best, some homo sapiens will not be your favorite; you’d have to be a saint to love every single person you’ve ever met. And unfortunately, the patients we’re handed in this job are rarely at their best. That’s why they’re in an ambulance. Expecting someone to present a winning smile while they’re dying may be unreasonable.

The trouble is that showing compassion and doing your very best for people is a lot easier when you like them. It’s just human nature; we’re always nicer to the people we identify with, get along with, and find affable and likable.

. . . a lot of ordinary people look totally uncool, especially in their BVDs. In fact, they’re pretty ugly without their clothes on, or at least a little make-up. Some of them are fairly dim bulbs, actually. And on the worst days of their lives, a lot more have BO, bad breath, wrinkles, loose skin, irregular teeth, big bellies, short penises, hair where there shouldn’t be hair, and no hair where there should be. They’re inarticulate, clumsy and, well, kind of ordinary. They don’t match any of those pictures of perfectly proportioned people you’ve seen in your textbooks or on TV.

And guess what? Their families love them dearly, just the way they are!

. . . What you are is a caregiver. What you’re not is a judge. . . . You can be one or the other, but you can’t be both — not at the same time, anyway. As a caregiver, you can’t let yourself slip into the trap of judging people you don’t know anything about, because it does bad things to you. (People Care, 16)

See, the tough thing is that although it’s very human to treat the likable people better, that’s not how this job works. You’re allowed to like whomever you want; that’s your right as a person. But your responsibility as a caregiver is to do your best for all of them, like or loathe. It’s a learned skill, because it’s not at all natural. But it helps if you remember that your standards for likability are far from the ultimate test of someone’s personal worth. Everyone’s fighting their own battles, and patients shouldn’t be expected to look pretty for you in the midst of theirs. You’re not here to add to their burdens.

We have a built-in bias that tells us that people who are smelly or fat or dumb are overall bad people. It’s hard to overcome it. And because people who are choking, or incontinent, or hospitalized tend to be especially rough around the edges, it’s very easy indeed to file them under the category of “unpleasant objects.”

Special mention should be given to patients who are, to put it simply, jerks. Even those of us who can look past physical and mental defects may have trouble treating the world’s biggest asshole like our own dear mother. Once again, we have to remember that we’re not playing this game on a personal level, and the question isn’t whether the patient will be invited to our birthday party. The question’s whether they deserve our best care — and whether or not that’s difficult, whether or not we want to give it, the answer is “yes.” That’s how this works. If they’re a patient, they get our best. Some nasty physical ailments are harder to treat than others; some personalities are likewise harder to tolerate. But we don’t get to pick and choose, so we just have to suck it up and be compassionate professionals across the board.

Try to develop the mindset that to be human carries an inherent sacredness, value, and dignity. And that even the most despicable and worn-out creature on your stretcher has the same needs and feelings, and likely the same sense of self-worth, as any CEO or socialite. To quote Antoine de Saint-Exupéry, “I have no right to say or do anything that diminishes a man in his own eyes. What matters is not what I think of him, but what he thinks of himself. Hurting a man in his dignity is a crime.” (From How to Win Friends and Influence People, 214.)

All of this isn’t easy. Striving toward it is a constant effort. But if you can take a patient who you truly loathe, and treat him just the same as you would your own child — or your partner — or yourself — then that’s something to celebrate. Because quite frankly, the patient is somebody’s child, or somebody’s partner, and odds are good that their opinions of his human worth may differ from yours.

. . . until the curtain was rung down on the last act of the drama (and it might have no last act!) he wished the intellectual cripples and the moral hunchbacks not to be jeered at; perhaps they might turn out to be the heroes of the play. (George Santayana on William James [from Linda Simon’s William James Remembered])